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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/30/2024
Date Signed: 04/30/2024 10:10:18 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230717113356
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:MEIR SHAUL YITZI TEICHMANFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: DATE:
04/30/2024
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Assistant Administrator Andrew DeVera TIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Residents died due to staff neglect
Staff did not prevent resident from using illegal drugs
Staff are not ensuring residents are seen by physicians
INVESTIGATION FINDINGS:
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On 4/30/2024 at 8:35 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced subsequent complaint investigation and a Case management visit to deliver findings on the investigation conducted by Investigation Branch (IB) investigator Jose Santana. Upon arrival LPA met with Assistant Administrator Andrew De Vera and the purpose of the visit was discussed.

The investigation consisted of the following: The investigation consisted of: LPA collected copies of Dewey pest control bill dated 7/1/2023, Staff roster, Client Roster and took photos of bed bugs in room #7. LPA reviewed C1 and C2's file and collected copies of their admission agreement, needs and services plan, Identification and Emergency Information, Preplacement appraisal information, Appraisal needs and services plan, and medications list. LPA additionally conducted a tour of the physical plant. IB investigator Jose Santana interviewed staff, clients, family members and medical professionals. Investigator Santana also reviewed medical records of C3 and C4, Review Pico Rivera police records, pharmacy records of C1.
Report Continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20230717113356
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
VISIT DATE: 04/30/2024
NARRATIVE
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Allegation: Staff are not ensuring residents are seen by physicians. It is alleged that the clients do see a physician. The investigation revealed that a physician visits the facility monthly. Current clients state providers visit the facility monthly, and it is announced beforehand. The facility maintains that if a resident asks for medical attention, they will provide transportation. There is insufficient evidence to corroborate the allegation.

Allegation: Residents died due to staff neglect. It is alleged that residents have died because they have not seen a doctor. Investigation revealed that there were two clients known to have died at the facility within the past 2 years. 1 out of the 2 clients saw the physician 2 months prior to their death. 1 out of 2 clients had a history of heart problems and saw a physician 2 weeks prior to their death. Current clients state providers visit the facility monthly, and the facility maintains that if a resident ask for medical attention, they will provide transportation. There is insufficient evidence to corroborate the allegation.

Allegation: Staff did not prevent resident from using illegal drugs. It is alleged that C1 smokes Methamphetamines. Investigation revealed that C1 has had on going issues since 2019 with drug addiction. The facility staff has admitted to seeing signs of C1 being under the influence. C1 also admitted to using drugs within the facility a week prior to interview with the IB investigator. C1 also stated the drug was acquired from another client at the facility. After file review C1 received one warning in 2019. Since the facility can not prevent the clients from using drugs the allegation will be unsubstantiated. A Case management will be issued for the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED.



An exit interview was conducted with Assistant Administrator Andrew De Vera. A copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2